PM 06-08-01-c: Copay Met (All Kids/FamilyCare Share and Premium)

All Kids/FamilyCare Share & Premium Level 1

Under All Kids/FamilyCare Share and Premium Level 1, a family's copay maximum is $100 per year. Once a family pays $100 in copays, they are responsible for sending the receipts to the HFS All Kids Unit in Springfield. The All Kids Unit determines if the copay maximum is met.

If the copay maximum is met, an indicator is put on the Client Database (CDB) and on Form 552 by the All Kids Unit. A central notice is sent to the family. The next FamilyCare Identification Card sent to the family will have a message that says the provider can no longer collect a copay from the family.

If the family submits receipts and the copay maximum is not met, the All Kids Unit sends the family a notice that explains this.

When a new 12-month eligibility period is set up, the copay limit must be met again. The computer system automatically resets the indicator on the CDB and Form 552 when this happens.

All Kids Premium Levels 2

Under All Kids Premium Level 2, children have a maximum copayment for hospital services only. The annual maximum copayment is $500 per child for hospital services. The copay maximum is tracked per child by plan year. The plan year is the same as the state fiscal year (July through June) regardless of when a case is approved.

Note: There is no copayment maximum for adults in FamilyCare Premium Levels 2 and 3.